ROBERT SIEGEL, HOST:
Health workers in Haiti are starting a pilot project to vaccinate 100,000 people against cholera. If Haiti can find the funds, advocates hope to vaccinate millions. Cholera was introduced there 18 months ago, most likely by U.N. peacekeepers troops from Nepal. So far, more than a half-million people have gotten sick and 7,000 have died. To make matters worse, public health authorities say the disease will stay in the environment for a long time.
That's because Haiti has the worst sanitation in this hemisphere, as NPR's Richard Knox reports.
RICHARD KNOX, BYLINE: An important thing to know about Port-au-Prince is that it's a city the size of Chicago and it doesn't have a sewer system.
Pediatrician Vanessa Rouzier shows us what that means. She gives us a tour of a slum called Cite de Dieu - City of God. Forty thousand people live here, including a lot of her patients.
DR. VANESSA ROUZIER: Some people have kind of homemade latrines.
KNOX: So basically there are no proper toilets for 40,000 people, right?
ROUZIER: That's correct.
KNOX: Canals that bring sewage down from the rest of the city cut through this slum.
ROUZIER: We just crossed one of those canals, right? So if you can imagine that human waste goes through there, and if it rains, they just really spill into the environment and eventually end up in the sea.
KNOX: Rouzier takes us down to a small beach on the edge of the slum. She points to a ramshackle structure that sits on stilts over the water. It's an outhouse.
ROUZIER: If you live close by to the water, you may use these over-the-sea-hanging toilets during the daytime. And at night, you clearly will not come out in the dark to use that. But you would have a bowel movement in some sort of plastic bag or something, and come out and throw it out during the day out here.
KNOX: Next to the outhouse, a small fishing boat unloads its cargo. And right there on the beach, a woman sells the fish from plastic buckets.
WILFRED ELMA: (Foreign language spoken)
UNIDENTIFIED WOMAN: (Foreign language spoken)
ELMA: Fish from the sea.
UNIDENTIFIED WOMAN: Paroquet(ph).
KNOX: But there are signs of hope. Only a hundred yards from this outhouse is a tidy-looking school with a brand-new, honest-to-god toilet.
ELMA: This is for the boys. This is for the teacher. And this is for the girls
KNOX: Principal Wilfred Elma says it's making a huge difference for his students.
UNIDENTIFIED MAN: (Foreign language spoken)
ELMA: And this is the first time they are, you know, using a toilet that smells so good. And they're breathing well.
ROUZIER: I think it's amazing. These children have never had the experience of using a toilet? I don't think many listeners in North America understand what that represents, that it's the first time they're using a proper toilet.
KNOX: And not only that, but this toilet is a bio-digester. It recycles waste and turns it into methane gas. The principal says they'll use it for cooking. It's a small step toward solving an overwhelming problem.
(SOUNDBITE OF TRUCK)
KNOX: An hour outside of Port-au-Prince, there's something even more exciting, a brand-new sewage treatment plant. It's the first one in Haiti. It sits in a windswept moonscape at the foot of what they call Goat Mountain.
WILSTON ETIENNE: We're standing on the unloading bay. So that's where the trucks come and they unload.
KNOX: This is where it all starts.
ETIENNE: That's where it all starts.
KNOX: That's Wilston Etienne, who works for Haiti's relatively new water and sanitation agency. He oversees the treatment plant.
Dozens of trucks bring raw sewage here every day from Port-au-Prince.
(SOUNDBITE OF TRUCK)
KNOX: We jump back, as one of them discharges the stuff into a treatment pond. Port-au-Prince will probably never have the kind of sewage system Americans are used to - underground pipes that carry waste to a treatment plant. But this one way is better than none at all and it's far cheaper. Amazingly, this plant and another one that's about to open will handle the city's entire output.
ETIENNE: So it's a huge, huge step in terms of raising the level of sanitation in Haiti.
KNOX: And soon, there'll be treatment plants like this one in seven other Haitian cities. But Etienne says better sanitation will take a lot more than building treatment plants. A lot of Haitians lives on less than $2 a day. And most don't even think about putting in a toilet when they build a house.
ETIENNE: So, when you make $2 a day and you have to feed your family, the last thing you think of is sanitation.
KNOX: In fact, access to sanitary facilities in Haiti has actually gone down over the last two decades. The facilities don't have to be the sleek flush toilets Americans are used to.
ETIENNE: I remember when I was young. Our first toilet was not a sanitary toilet. It was a pit outside, you know, that had a piece of board on it with a hole in it. And I was fine.
(SOUNDBITE OF LAUGHTER)
KNOX: But change isn't going to be easy. Now, a night-time army of people shovel out the septic tanks and pits of those who have them and dump the stuff into canals.
Etienne says that's got to stop.
ETIENNE: Changing people's behavior is not something that's going to happen overnight. Let's not fool ourselves, you know. No matter how many billions of dollars we have, you know.
KNOX: The first step, he says, is to convince Haitians that when it comes to sanitation, things don't have to be like they are now.
Richard Knox, NPR News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.